“Last year the pressures were intolerable. Services were stretched up to, and in some places beyond, breaking point.

“This time preparations have never been more thorough,” he said.

“But we have to recognise we are not where we would want to be as we head into winter.

“The NHS is already under severe pressure, and while the additional funding in the recent Budget is welcome, it has come very late to be used to maximum effect.

“We can not say with certainty how tough this winter will be, but the likelihood is that services will be sorely tested,” he said. Later today the NHS will publish the first set of weekly figures showing how hospitals are coping as winter sets in.

Latest published bed occupancy levels, general and acute beds, highest five